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Objectives Prior studies have found that adverse childhood experiences (ACEs) are associated with asthma prevalence and onset, presumably related to stress and increased inflammation. We hypothesized that ACEs may be associated with asthma severity as well. We studied the 2016–2017 US National Survey of Children's Health dataset to explore the relationship between ACEs and pediatric asthma severity. Methods We analyzed children ages 0 to 17 years old who had current caregiver-reported asthma diagnosed by a healthcare provider. We reported descriptive characteristics using chi-square analysis of variance (ANOVA) and used multivariable regression analysis to assess the relationship of cumulative and individual ACEs with asthma severity. Survey sampling weights and SAS survey procedures were implemented to produce nationally representative results. Results Our analysis included 3691 children, representing a population of 5,465,926. Unadjusted analysis demonstrated that ACEs – particularly household economic hardship, parent/guardian served time in jail, witnessed household violence, or victim/witness of neighborhood violence – were each associated with higher odds of moderate/severe caregiver-reported asthma. After controlling for confounders possibly associated with both exposure (ACEs) and outcome (asthma severity), children who witnessed parent/adult violence had higher adjusted odds of caregiver-reported moderate/severe asthma. (1.67, confidence interval 1.05–2.64, P = .03) Conclusions Intrafamilial witnessed household violence is significantly associated with caregiver-reported moderate/severe asthma.

Background: The aim of this research is to assess the level of physical activity (PA) in relation to different socio-economic factors and to examine the effect of the recommended level of PA on the domains of quality of life (QoL) among residents of low-income housing in the metropolitan area of Kuala Lumpur, Malaysia. Methods: This was a cross-sectional study that included 680 respondents from community housing projects. Reported PA was assessed using the Global Physical Activity Questionnaire (GPAQ) short form version 2. The SF-12v2 was administered to assess the health-related QoL (HRQoL) among the study population. Respondents were grouped into “active” and “insufficient” groups according to reported weekly PA level. One-way analysis of variance, analysis of co-variance, and multiple linear regression were used in the analysis. Results: Overall, 17.6% (95% CI, 14.3–20.9) of the respondents did not achieve the recommended levels of PA (≥600 metabolic equivalent [MET]-minutes week−1). Level of achieving recommended PA was higher among younger participants, females, members belonging to nuclear families, and in self-employed participants. The group that fulfilled recommended PA levels (active) has higher levels of QoL in all domains except physical functioning. Conclusions: Almost one out of five low-income urban residents were physically inactive. In addition, individuals who attained recommended PA levels had better scores on some domains of HRQOL than those who did not. Our findings call for tailor-made public health interventions to improve PA levels among the general population and particularly for low-income residents.

Objective: The purpose of the study was to examine the relationship of maternal complications during pregnancy and prenatal exposures with childhood asthma among low-income families in Karachi, Pakistan. Methods: Parents/guardians of children with and without asthma visiting a charity hospital were enrolled. Information about prenatal and perinatal exposures was collected. Univariable and multiple stepwise logistic regression analysis were conducted to explore the relationship of socio-demographic, maternal complications during pregnancy, access to prenatal care, and exposure to animals and pests while pregnant with childhood asthma. Results: Maternal symptoms of nocturnal cough (adjusted OR [aOR = 2.87, 95% CI = 1.60-5.14) and wheezing (aOR = 5.57, 95% CI = 2.32-13.37) during pregnancy significantly increased the odds of childhood asthma. The family history of asthma or hay fever, also elevated the odds of childhood asthma (adjusted OR [aOR] = 5.86 (3.03-11.34). The odds of asthma among children whose mothers received prenatal care by Dai, an unskilled health worker, were significantly elevated. Lastly, prenatal exposure to rats/mice and contact with goats while pregnant was significantly associated with childhood asthma. Whereas, prenatal exposure to cows/cattle reduces the odds of childhood asthma. Conclusions: This study identified important maternal and prenatal risk factors for childhood asthma, the majority of which are avoidable. Appropriate steps are needed to create awareness about the prenatal risk factors in this population.

In the global context, health and the quality of life of people are adversely affected by either one or more types of chronic diseases. This paper investigates the differences in the level of income and expenditure between chronically-ill people and non-chronic population. Data were gathered from a national level survey conducted namely, the Household Income and Expenditure Survey (HIES) by the Department of Census and Statistics (DCS) of Sri Lanka. These data were statistically analysed with one-way and two-way ANOVA, to identify the factors that cause the differences among different groups. For the first time, this study makes an attempt using survey data, to examine the differences in the level of income and expenditure among chronically-ill people in Sri Lanka. Accordingly, the study discovered that married females who do not engage in any type of economic activity (being unemployed due to the disability associated with the respective chronic illness), in the age category of 40–65, having an educational level of tertiary education or below and living in the urban sector have a higher likelihood of suffering from chronic diseases. If workforce population is compelled to lose jobs, it can lead to income insecurity and impair their quality of lives. Under above findings, it is reasonable to assume that most health care expenses are out of pocket. Furthermore, the study infers that chronic illnesses have a statistically proven significant differences towards the income and expenditure level. This has caused due to the interaction of demographic and socio-economic characteristics associated with chronic illnesses. Considering private-public sector partnerships that enable affordable access to health care services for all as well as implementation of commercial insurance and community-based mutual services that help ease burden to the public, are vital when formulating effective policies and strategies related to the healthcare sector. Sri Lanka is making strong efforts to support its healthcare sector and public, which was affected by the coronavirus (COVID-19) in early 2020. Therefore, findings of this paper will be useful to gain insights on the differences of chronic illnesses towards the income and expenditure of chronically-ill patients in Sri Lanka.

Dietary behavior change is difficult to accurately measure in a low-income youth population. Objective tools to measure fruit and vegetable consumption without relying on self-report present the opportunity to do this with less respondent burden and bias. A promising tool for quantifying fruit and vegetable consumption via proxy is skin carotenoids as measured by reflection spectroscopy through a device called the Veggie Meter®. To assess whether the Veggie Meter® is able to detect changes in skin carotenoids as a proxy for fruit and vegetable consumption in a low-income school setting, skin carotenoid measurements were collected at three time points, along with student level demographics, anthropometric measurements, and nutrition knowledge. A secondary goal of this study was to refine the protocol to be used based on researcher observations. Repeated measures analysis of variance with Bonferroni correction for multiple comparisons indicate that there was a significant difference in VM scores over the course of the study (F(2, 68) = 6.63, p = 0.002), with an increase in skin carotenoids from Fall 2018 to Spring 2019 (p = 0.005). This increase was sustained over the summer months when measured in Fall 2019. Changes to the protocol included the addition of a hand cleaning step and using the non-dominant ring finger for data collection. With these refinements, the results demonstrate that the Veggie Meter® is usable as a non-invasive tool for measuring fruit and vegetable consumption in a population that is traditionally difficult to assess.

To evaluate the impact of the University of Kentucky's Healthy Choices for Every Body (HCEB) adult nutrition education curriculum on participants' food resource management (FRM) skills and food safety practices.A quasi-experimental design was employed using propensity score matching to pair 8 intervention counties with 8 comparison counties. Independent-samples t tests and ANCOVA models compared gains in FRM skills and food safety practices between the intervention and comparison groups (n = 413 and 113, respectively).Propensity score matching analysis showed a statistical balance and similarities between the comparison and intervention groups. Food resource management and food safety gain scores were statistically significantly higher for the intervention group (P .001), with large effect sizes (d = 0.9) for both variables. The group differences persisted even after controlling for race and age in the ANCOVA models.The HCEB curriculum was effective in improving the FRM skills and food safety practices of participants.

Objective Low-income Hispanic women are at greater risk for dietary deficiencies and obesity. We assessed the association between Supplemental Nutrition Assistance Program participation and dietary intake among 661 Hispanic women aged 26–44 years living in Texas. Methods Cross-sectional data was collected using standard methods. Analysis of variance and logistic regression examined the influence of Supplemental Nutrition Assistance Program on diet after adjusting for household characteristics, body mass index, and food security status. Results Most women did not meet recommended dietary guidelines. Supplemental Nutrition Assistance Program participants consumed higher amounts of total sugars, sweets–desserts, and sugar-sweetened beverages than Supplemental Nutrition Assistance Program nonparticipants. High sodium intakes and low dairy consumption were observed in both groups. Only 27% of low-income eligible women received Supplemental Nutrition Assistance Program benefits. Discussion Low-income Hispanic women participating in Supplemental Nutrition Assistance Program reported less healthful dietary patterns than nonparticipants. This may contribute to the increased obesity prevalence and related comorbidities observed in this population. Conclusion Supplemental Nutrition Assistance Program should play an important role in enhancing the overall dietary quality of low-income households. Policy initiatives such as limiting the purchase of sugar-sweetened beverages and education to enable women to reduce consumption of high sodium processed foods deserve consideration as means to improve the dietary quality of Supplemental Nutrition Assistance Program participants. Effective measures are needed to increase Supplemental Nutrition Assistance Program participation rates among Hispanics.

Background Poor menstrual knowledge and access to sanitary products have been proposed as barriers to menstrual health and school attendance. In response, interventions targeting these needs have seen increasing implementation in public and private sectors. However, there has been limited assessment of their effectiveness. Objectives Assess the impact of providing reusable sanitary pads and puberty education on girls’ school attendance and psychosocial wellbeing outcomes. Methods A cluster quasi-randomised controlled trial was conducted across 8 schools, including 1124 girls, in rural Uganda. Schools were allocated to one of four conditions: the provision of puberty education alone; reusable sanitary pads alone; puberty education and reusable sanitary pads; and a control (no intervention). The primary outcome was school attendance. Secondary outcomes reflected psychosocial wellbeing. Results At follow-up, school attendance had worsened for girls across all conditions. Per-protocol analysis revealed that this decline was significantly greater for those in the control condition d = 0.52 (95%CI 0.26–0.77), with those in control schools having a 17.1% (95%CI: 8.7–25.5) greater drop in attendance than those in any intervention school. There were no differences between the intervention conditions. High rates of school drop-out and transfer meant the trial suffered from substantial participant drop-out. Intention-to-treat analyses using two different imputation strategies were consistent with the main results, with mean differences of 5.2% attendance in best-case and 24.5% in worst-case imputations. Results were robust to adjustments for clustering. There was no impact of the interventions on girls’ self-reported shame or insecurity during menstruation. Conclusion Results of the trial support the hypothesised positive impact of providing sanitary pads or puberty education for girls’ school attendance in a developing country context. Findings must be interpreted with caution in light of poor participant retention, intervention fidelity, and the attendance measures used. Trial Registration Pan African Clinical Trials Registry PACTR201503001044408

BACKGROUND: Hypogonadism is common with opiate-like drug use and may contribute to cognitive abnormalities. With the increasing epidemic of HIV and substance use (SU) worldwide, it is important to understand the impact of these conditions on cognition, which may affect quality of life and possibly decrease adherence to treatment. We hypothesized that men with SU, by virtue of hypogonadism secondary to HIV and/or SU, may demonstrate impaired cognition. METHODS: We recruited men aged 18-50 from a population of low income, inner-city individuals. Details of HIV and SU status, serum blood levels of total testosterone (TT), free testosterone (FT) and estradiol (E2) were assessed. All subjects were administered ten neuropsychological tests. RESULTS: Our sample consisted of 68 men (mean age: 43.2 years (SD 5.8), African Americans: 86.6%). The recruited population was primarily from low socioeconomic status and unemployed. The mean level of TT was 553.9ng/dL (SD 262.0), the mean level of FT was 69.5pg/mL (SD 34.8), mean E2 was 3.2pg/mL (SD 4.4). We found that 30.9% were hypogonadal and it was associated with higher SU. We observed some relationships between sex hormones and cognitive domains, however, after adjustment for age, drug use category, education, depression, HIV, there was no statistically significant correlation between cognitive performance and sex hormone levels. CONCLUSIONS: In this cross-sectional study of men with a high prevalence of SU and hypogonadism, endogenous levels of TT, FT or E2 were not related to cognitive performance. Other factors need to be identified which may contribute to poor cognitive function in the setting of SU. Language: en

A cross-sectional study was undertaken in Nakuru, Kenya to assess the prevalence of refractive error and the spectacle coverage in a population aged ≥50 years. Of the 5,010 subjects who were eligible, 4,414 underwent examination (response rate 88.1 %). LogMAR visual acuity was assessed in all participants and refractive error was measured in both eyes using a Topcon auto refractor RM8800. Detailed interviews were undertaken and ownership of spectacles was assessed. Refractive error was responsible for 51.7 % of overall visual impairment (VI), 85.3 % (n = 191) of subjects with mild VI, 42.7 % (n = 152) of subjects with moderate VI, 16.7 % (n = 3) of subjects with severe VI and no cases of blindness. Myopia was more common than hyperopia affecting 59.5 % of those with refractive error compared to 27.4 % for hyperopia. High myopia (-5.0 DS) was also more common than extreme hyperopia (+5.0 DS). Of those who needed distance spectacles (spectacle coverage), 25.5 % owned spectacles. In conclusion, the oldest, most poor and least educated are most likely to have no spectacles and they should be specifically targeted when refractive services are put in place.

BackgroundPoverty may moderate the effect of treatment of depression in low-income countries.AimsTo assess poverty and lack of empowerment as moderators of a cognitive-behavioural therapy (CBT)-based intervention for perinatal depression in rural Pakistan.MethodUsing secondary analysis of data from a randomised controlled trial (trial registration: ISRCTN65316374) we identified predictors of depression at 1-year follow-up and moderators of the intervention (n=791).ResultsPredictors of follow-up depression included household debt, the participant not being empowered to manage household finance and the interaction terms for these variables with the trial arm. Effect sizes for women with and without household debt were 0.80 and 0.55 respectively. The effect size for women in debt and not empowered financially was 0.94 compared with 0.50 for women with neither of these factors.ConclusionsOur findings demonstrate the importance of household debt and lack of financial empowerment of women as important maintaining factors of depression in low-income countries and our locally developed intervention tackled these problems successfully.

SummaryBody mass index (BMI) is a good indicator of nutritional status in a population. In underdeveloped countries like Bangladesh, this indicator provides a method that can assist intervention to help eradicate many preventable diseases. This study aimed to report on changes in the BMI of married Bangladeshi women who were born in the past three decades and its association with socio-demographic factors. Data for 10,115 married and currently non-pregnant Bangladeshi women were extracted from the 2007 Bangladesh Demographic and Health Survey (BDHS). The age range of the sample was 15–49 years. The mean BMI was 20.85±3.66 kg/m2, and a decreasing tendency in BMI was found among birth year cohorts from 1972 to 1992. It was found that the proportion of underweight females has been increasing in those born during the last 20 years of the study period (1972 to 1992). Body mass index increased with increasing age, education level of the woman and her husband, wealth index, age at first marriage and age at first delivery, and decreased with increasing number of ever-born children. Lower BMI was especially pronounced among women who were living in rural areas, non-Muslims, employed women, women not living with their husbands (separated) or those who had delivered at home or non-Caesarean delivery.

While the health status of Americans has generally improved over time, health disparities among groups of the population have been pervasive. Designing a measure that tracks the resulting disparities remains a challenge. In this paper, we propose a new measure of health disparities the Symmetrized Theil Index (STI), and derive its design-based sampling variance in grouped survey data. Because STI is symmetric, it circumvents the drawback of the Theil Index in how groups are weighted: indeed, the latter is mostly influenced by groups with high disease frequencies. Moreover, STI is related to Pearson's chi-square test of independence for binary data, and to the F-test in one-way analysis-of-variance for continuous data. We illustrate our approach using data on dental caries for children and adolescents from the third National Health and Nutrition Examination Surveys (NHANES III; 1988-1994) and NHANES 1999-2004. Tooth decay remains the most common chronic disease in U.S. children and adolescents. Although their oral health has generally improved, we find no change in the prevalence or severity of untreated tooth decay in U.S. children and adolescents between surveys. These findings are consistently observed for both the overall STI and its between-group component across gender, race/ethnicity, country of birth, survey respondent's education, income and poverty-income ratio.

Objectives We examined (1) whether attending out-of-home day care centres (DCCs) has differential effects on improvement of child nutrition and facilitation of maternal employment depending on availability of non-institutionalised childcare support and (2) whether attendance increases infectious diseases. Methods In a prospective before–after comparison study at public DCCs in Pokhara, Nepal, we compared weight-for-age Z -score (WAZ) and height-for-age Z -score (HAZ) among children attending DCCs between at admission, after 6 months, and after 1 year and determined differential changes in these measures between those with and without appropriate childcare support. We used repeated measures analysis of variance with interaction terms between support availability and DCC attendance. We compared maternal income and incidence of diarrhoea and fever in children between the periods of waiting and attending. Results After 6 months, neither WAZ nor HAZ significantly changed. After 1 year, WAZ significantly improved, but HAZ did not change among all participants. Those without appropriate childcare support showed greater improvement in both WAZ and HAZ than those with support. While children were attending, income increased only among those mothers who were already working without any childcare support at baseline. Neither diarrhoea nor fever increased. Conclusions DCCs can be more beneficial for child nutrition and working mothers in households lacking childcare support than in those with support.

Developing country urban contexts present multiple challenges to those responsible for ensuring the good health of urban populations. These include urban growth, migration, informal settlements, intra-urban inequalities and - in some cases - high HIV prevalence. Using Johannesburg as a case study, this paper explores the complexities of the urban context by comparing the social determinants of urban health between migrant groups residing in the inner-city and a peripheral urban informal settlement. It is argued that any attempt to improve the health of urban populations in the context of migration and HIV requires understanding that 'place matters'.

This study examines changes in the characteristics of the homeless population before and after a period of extended economic expansion (1992-2002). Data from other sources suggest that, during this 10-year period, the size of the overall population of homeless persons may have declined slightly, though not significantly, both in the city studied and nationally. In-depth surveys of representative samples of homeless adults (N = 249 in 1992-94; N = 220 in 2000-2002) revealed significant differences in the composition of the homeless population across the time period, consistent with queuing theory. Persons experiencing homelessness after the expansion appeared to be a more "chronic," less readily employable population than those interviewed at the start of the expansion: Those interviewed after were older, spent more time living on the streets, had more health symptoms, were more likely to have a diagnosis of schizophrenia, and had more restricted social networks and social support. Policy, research, and service provision implications of the findings are discussed.

Prior studies have shown low-income African Americans have low intakes of fruits and vegetables, which correlate, in part, to area of residence. To address the dietary problem, behavior-change interventions are most effective when they are theoretically based and compatible with cultural/behavioral characteristics of a given population.To use the Transtheoretical Model of Behavior Change to determine whether low-income African Americans were in proportionately different stages of change for increasing fruits and vegetables to their young children and identify differences in decision making, self-efficacy, and use of cognitive and behavioral strategies related to fruit and vegetable availability.The two-phase, descriptive study utilized a mixed methodology consisting of a fruit and vegetable survey and focus groups.Convenience sample of low-income African-American parents with children enrolled in an urban area Head Start program.chi(2) test was calculated to examine the distribution of parents into stages of change for increasing fruit and vegetable availability. Analysis of variance was used to test differences in fruit and vegetable availability to children and parents' decision making, self-efficacy, and use of cognitive and behavioral strategies. Content analysis of focus group transcripts was used to triangulate quantitative findings and further explore meanings of survey responses.Of 94 participants completing the fruit and vegetable survey, 21% staged as precontemplation/contemplation, 25% staged as preparation, and 54% staged as action/maintenance (P0.001). Parents in action/maintenance stages served significantly more fruits and vegetables (P=0.006) and used behavioral processes significantly more often (P0.001) compared to parents in precontemplation/contemplation stages. Content analysis of focus group transcripts provided greater insight into the quantitative findings.Nutrition education targeting low-income African-American parents in earlier stages of change should address planning and preparing convenient and economical meals and snacks that include fruits and vegetables. Interventions targeting parents in later stages of change should address increasing variety and healthful preparation methods. Interventions for both groups can benefit from social support strategies.

Objectives. We examined the effect of economic assets on sexual risk-taking intentions among school-going AIDS-orphaned adolescents in rural Uganda. Methods. AIDS-orphaned adolescents from 15 comparable schools were randomly assigned to control (n = 133) or treatment (n = 127) conditions. Treatment participants received child savings accounts, workshops, and mentorship. This economic intervention was in addition to the traditional care and support services for school-going orphaned adolescents (counseling and school supplies) provided to both treatment and control groups. Adolescents in the treatment condition were compared with adolescents in the control condition at baseline and at 10 months after the intervention. Results. After control for sociodemographic factors, child-caregiver/parental communication, and peer pressure, adolescents in the economic intervention group reported a significant reduction in sexual risk-taking intentions compared with adolescents in the control condition. Conclusions. The findings indicate that in Uganda, a country devastated by poverty and disease (including HIV/AIDS), having access to economic assets plays an important role in influencing adolescents' sexual risk-taking intentions. These findings have implications for the care and support of orphaned adolescents, especially in poor African countries devastated by poverty and sexually transmitted diseases.

A randomised controlled trial evaluated the Aussie Optimism Program in preventing anxiety and depression. Grade 7 students (n = 496) from disadvantaged government schools in Perth Western Australia, participated. Six schools were randomly assigned to Aussie Optimism and six schools received their usual health education lessons. Students completed questionnaires on depression, anxiety, attribution style, and social skills. Parents completed the Child Behavior Checklist. No significant group effects were found for student-reported data. Parents of intervention group only students reported reductions in internalizing problems at post-test. No follow-up group effects were significant. Students and teachers found the program acceptable.

Our study extends research on the feminization of poverty by analyzing the variation in women's, men's, and feminized poverty across affluent democracies from 1969 to 2000. Specifically, we address three issues. First, we provide more recent estimates of adult women's and men's poverty and the ratio of women's to men's poverty with two different poverty measures. We suggest that by incorporating the elderly, the feminization of poverty may be greater than previously estimated. The feminization of poverty is nearly universal across affluent Western democracies 1969-2000. Second, we show that women's, men's and overall poverty are highly correlated, but the feminization of poverty diverges as a distinct social problem. Third, we find that women's, men's and overall poverty share several correlates, particularly the welfare state, though some differences exist. At the same time, several of our findings differ with past research. The feminization of poverty is only influenced by social security transfers, single motherhood and the sex ratios of the elderly and labor force participation. While power resources theory probably best explains women's, men's and overall poverty, structural theory may best explain the feminization of poverty. We conclude by discussing how analyses of the feminization of poverty contribute to debates on poverty and gender inequality.

Purpose. To examine the efficacy of a stage-targeted physical activity intervention among low-income African-Americans. Methods. 207 participants were randomly assigned to groups and administered baseline measures. Intervention participants were mailed stage-targeted physical activity information, whereas control participants received low-sodium diet brochures. Measures were readministered by phone 1 and 6 months later, with response rates of 69% and 46%, respectively. Results. 69% of participants were African-American and 64% had a monthly household income of 2 test. Gains attenuated by 6 months. Conclusions. The current study supports the use of this intervention among low-income African-Americans. Limitations include use of self-report measures and small sample size.

ObjectiveTo assess the prevalence of household food insecurity (FI) in France and to describe its associations with socio-economic factors, health behaviours, diet quality and cost (estimated using mean food prices).DesignCross-sectional nationally representative survey. FI was assessed using an adapted version of the US Department of Agriculture’s Food Insufficiency Indicator; dietary intake was assessed using a 7 d open-ended food record; and individual demographic, socio-economic and behavioural variables were assessed using self-administered questionnaires and interviews. Individuals experiencing FI were compared with food-secure individuals, the latter being divided into four categories according to quartiles of their income per consumption unit (FS1 to FS4). Differences among categories were analysed usingχ2tests, ANOVA and tests for trend.SettingIndividual and National Dietary Survey (INCA2), 2006–2007.SubjectsAdults aged 18–79 years (n2624).ResultsIndividuals experiencing FI represented 12·2 % of the population. They were on average younger, more frequently women and single parents with children compared with those in the other four categories. Their mean income per consumption unit was higher than that in the FS1 category, but they reported poorer material and housing conditions. The prevalence of smoking and the mean daily time spent watching television were also higher in the FI category. No significant difference among categories was found for energy intake, but mean intakes of fruits, vegetables and fish were lower, and diet quality was slightly but significantly poorer in the FI category. Daily diet cost was also lower in the FI category.ConclusionsFrance is not spared by FI. FI should be routinely monitored at the national level and research should be promoted to identify effective strategies to reduce nutrition inequalities in France.

Objectives. The present study examined the extent to which daily stressor severity and appraisals of the stressors accounted for socioeconomic disparities in health. Methods. Data from the National Study of Daily Experiences and the Midlife in the United States Survey were combined for the current analyses, resulting in 1,031 respondents who reported on 7,229 days. Results. Respondents without a high school degree experienced more severe stressors and appraised stressors as posing greater risk to their financial situation and to their self-concept than respondents with a high school or college degree. Differences in severity and stressor appraisal accounted for education differences in psychological distress and physical health symptoms. Discussion. Findings suggest the importance of considering variation across stressors, particularly implications for self-concept, in understanding sources of differential stressor vulnerability.

Measure climacteric symptoms in a low socio-economic Ecuadorian population with the Greene Climacteric Scale and determine factors involved with higher scorings.Women aged 40--65, non hormone therapy (HT) users, with intact uterus and ovaries, attending the Gynecologic Outpatient Service of the Enrique C. Sotomayor Obstetrics and Gynecology Hospital Guayaquil-Ecuador, were selected and asked to fill out the Greene Climacteric Scale.During the study period, 385 women met inclusion criteria and filled out the climacteric scale. Mean age of this sample was 47.6 +/- 5.5 years and 36.6% were agedor=50 years. Women were classified as: premenopausal 38.9%, perimenopausal 28.8% and postmenopausal 32.3%. The total Greene Climacteric score for postmenopausal was found to be higher than premenopausal total score (18.78 +/- 8.11 versus 16.31 +/- 7.62, p0.05). Total, clusters and subclusters scorings maintained an increasing trend from one menopausal status to the next. The most frequently and intensive presenting symptoms of the 21 symptoms composing the scale were: difficulty in concentrating, feeling unhappy or distressed, headaches, and hot flashes (n=385: 87, 82, 83.9 and 82%, anxiety and depression subclusters, and somatic and vasomotor clusters, respectively). Univariate analysis determined that ageor=47 years, parityor=4 and schooling12 years were associated to the risk for having a total Greene scoring ofor=18 (OR: [95% CI], 2.5[1.6-3.8]; 1.8[1.1-3]; 1.6[1-2.7], respectively, p0.05). Ageor=47 years was associated to increased rates of higher scorings in all clusters except for loss of sexual interest, which was contrarily increased together with vasomotor scoring in women with higher parity (p0.05). Women with educational level12 years were related to higher somatic scorings. Logistic regression analysis confirmed all these associations except for parity, which was excluded as a risk factor for higher vasomotor scorings.In this specific population, climacteric symptoms presenting in all menopausal groups, as measured with the Greene Climacteric Scale, resulted to be higher than previously reported standards and age, parity and educational level were independent risk factors.

Given the link between poverty and health, nurses, in their work in hospitals and in the community, often come into contact with people who are poor. To be effective care providers, nurses must have an adequate understanding of poverty and a positive attitude toward people who are poor. This study examined attitudes toward poverty among baccalaureate nursing students ( N = 740) at three Canadian universities. Students’ attitudes were neutral to slightly positive. Personal experiences appeared to have an important influence on the development of favorable attitudes. The findings point to several considerations for nursing curricula. Students should not only be provided with classroom opportunities for critical exploration of poverty and its negative effects on individuals and society, but also have clinical learning experiences that bring them face-to-face with people who are poor, their health concerns, and the realities of their circumstances. Thoughtful critique of poverty-related issues and interpersonal contact may be effective strategies to foster attitude change.

Tremendous health disparities exist across various segments of the United States population with rural women particularly at risk. African Americans have higher rates of death, disease, and disability than Caucasians. Although prevalence rates for alcohol and other drug use vary across studies, African American women generally report less use than Caucasians. However, African Americans disproportionately experience negative health and social consequence of AOD use. The findings of this study provide rare information about substance abuse in rural African American women. Specifically, this manuscript reports differences between rural African American and Caucasian women (n=267) on AOD use, comorbid Axis I disorders, and violence.

This article presents the results of a study of four Hispanic subgroup residents of New York City. Utilizing National Institute of Dental and Craniofacial Research criteria and a specially designed survey instrument, the authors conducted oral examinations and interviews on 1,010 Hispanic adults. Results showed that the oral health status and the indicators of treatment needs differed among the subgroups. When conducting needs assessment and providing oral health care services for this population, differences among the subgroups must be considered.

This research evaluated the psychometric properties of a brief self-report measure of HIV-related knowledge, the 18-item HIV Knowledge Questionnaire (HIV-KQ-18). Low-income men and women (N = 1,019) responded to 27 items that represented the domain of interest. Item analyses indicated that 18 items, with item-total correlations ranging from .24 to .57, be retained. Additional analyses demonstrated the HIV-KQ-18's internal consistency across samples (alphas = .75-.89), test-retest stability across several intervals (rs = .76- .94), and strong associations with a much longer, previously validated measure (rs = .93-.97). Data from three clinical trials indicated that the HIV-KQ-18 detected knowledge gains in treated participants when compared to untreated controls. We conclude that the HIV-KQ-18 is internally consistent, stable, sensitive to the change resulting from intervention, and suitable for use with low-literacy populations.

Background. Dementia health literacy is low among the public and likely poses a significant barrier to Alzheimer’s disease (AD) symptom recognition and treatment, particularly among minority populations already facing higher AD burden. We evaluated the pilot phase of a novel AD health education program, Old SCHOOL (Seniors Can Have Optimal Aging and Ongoing Longevity) Hip-Hop (OSHH), which is designed to enable children to be AD health educational conduits in the home (“child-mediated health communication”). Method. OSHH applied our stroke-validated model of engaging, dynamic, and age- and culturally appropriate curriculum delivered to elementary school-age children (fourth/fifth grades, ages 9-11 years). We assessed AD knowledge among the children at baseline, immediately following the intervention (1-hour program delivered daily over 3 consecutive days), and 3 months later. For key AD symptoms, we developed the FLOW mnemonic ( forget, lose, overlook, write/wander); students were additionally taught action plans for recognized symptoms. Results. Seventy-five students completed baseline assessments, and 68 completed posttesting. AD symptoms in FLOW were not well known at baseline (individually ranging from 16% to 71% correct) but were highly learned after 3 days (89% to 98% correct) and retained well after 3 months (80% to 95% correct, p ≤ .01 for all comparisons vs. baseline). AD localization, including its effect on memory and the hippocampus, was also highly learned and retained ( p < .001). Eighteen students (24%) reported having a close friend/family member with AD. Conclusions. This study suggests our hip-hop health education model may be an effective method to improve AD health literacy.

This study examined whether productive coping styles and social support were significant mediators of the relationship between academic stress and suicidal ideation. The survey was performed on a sample of 300 Malaysian and 300 Indian college students. The participants completed psychological assessments of productive coping styles, social support, academic stress, and suicidal ideation. Significant cultural and demographic differences emerged. Indian students reported higher suicidal ideation and academic stress than did Malaysian students, and Malaysian students received more social support and had better problem-solving coping styles than did Indian students. Overall, students who were male, non-religious, and from low-income families reported more academic stress and more suicidal ideation. Productive coping styles and overall social support strongly affected the relationship between academic stress and suicidal ideation among both countries’ participants.

Although individuals with poor food security might be expected to have reduced food intake, and thus reduced body fat and less likelihood of being overweight, these associations have not been adequately studied. The purpose of the current study was to examine the relationship between food insecurity and overweight as measured by body mass index (BMI) using data from the nationally representative 1994-1996 Continuing Survey of Food Intakes by Individuals (CSFII). Overweight was defined as BMI >27.3 kg/m(2) for women and 27.8 kg/m(2) for men. Food insecurity was related to overweight status for women (n = 4509, P < 0.0001), but not for men (n = 4970, P = 0.44). Excluding the 11 severely insecure women, the prevalence of overweight among women increased as food insecurity increased, from 34% for those who were food secure (n = 3447), to 41% for those who were mildly food insecure (n = 966) and to 52% for those who were moderately food insecure (n = 86). Food insecurity remained a significant predictor of overweight status, after adjustment for potentially confounding demographic and lifestyle variables (P < 0.01). In a logistic regression analysis, mildly insecure women were 30% more likely to be overweight than those who were food secure [odds ratio (OR) 1.3, P = 0.005]. Thus, food insecurity had an unexpected and paradoxical association with overweight status among women with a higher prevalence of overweight among the food insecure, and a resulting potential for increased incidence of obesity-related chronic diseases. Given that the rates of both overweight and food insecurity are on the rise, this research area warrants further investigation.

The parents of 151 children, ages 4-16 years, attending the pediatric outpatient clinic of an urban hospital were surveyed to determine if aggressive behavior among children of low literacy and low-income parents is related to excessive television viewing or to sociological variables such as ethnicity/race, education, occupation, and parents' marital status. The survey consisted of 22 questions about the ethnicity, marital status, education, and occupation of the parent, the television viewing behavior of the child, and the externalizing behavior scale of the Child Behavior Checklist of Achenbach (CBC). The television viewing habits of children in this study were not significantly different from viewing habits reported in national surveys of the US population. T scores in the aggression scale of CBC were unrelated to the hours of television watched by children and the control of viewing by the parent but were significantly associated with the employment and marital status of the mother. Children of unemployed and single mothers had higher externalizing-behavior scores, suggesting that family ecological variables may have more influence on children's behavior than the duration of television viewing.

Objective This study evaluated the Michigan Farmers' Market Nutrition Program in one Michigan county to determine its effect on fruit and vegetable consumption behavior. Subjects/Setting Subjects were selected from WIC and Community Action Agency populations: 564 low income women completed the pretest; 455 completed the posttest. Attrition rate was 19.3%. Intervention Subjects were assigned to one of 4 interventions: education about the use, storage and nutritional value of fruits and vegetables, distribution of farmers' market coupons, both education and coupons, or no intervention. Design Education-only and coupon and education groups were randomly assigned; clinic appointment timing determined assignment to no-intervention and coupon-only groups. Main Outcome Measures A self-administered questionnaire before and after intervention measured attitudes about fruit and vegetable consumption and intake of fruits and vegetables. WIC records documented redemption of coupons. Statistical Analyses Data analysis included 2-way multivariate analysis of covariance, univariate analysis of covariance, logistic regression, and covariance structure modeling. Results Both the education interventions and the coupon interventions had positive effects. Coupons had a direct effect on increasing fruit and vegetable consumption behavior but no effect on attitudes. Education had a direct effect on attitudes and seemed to exert an effect on consumption behavior through attitudes. The maximum impact of the intervention was achieved through a combination of education and coupons. Applications This study demonstrated that a low-income population may be more likely to increase its fruit and vegetable consumption behavior when incentives such as coupons improve affordability. J Am Diet Assoc. 2001;101:195-202.

Purpose: To examine the pattern of adolescent's involvement in drug-related behaviors and sexual initiation, and its relationship with: (a) age and gender, (b) sensation- seeking, (c) perceptions of peer and family risk involvement, and (d) involvement in high-risk sexual behavior. Subjects: Two hundred and sixty-one urban African-American youth, aged 9 to 15 years at baseline, who were sexually experienced by the end of the 4-year study interval. The longitudinal assessment (4 years) was focused on: (a) alcohol use, illicit drug use, and drug trafficking; (b) high-risk sex; (c) propensity to sensation seeking; and (d) perceived peer and family risk involvement. Results: Involvement increased over the 4-year study interval such that over half of the adolescents reported use of alcohol and/or use of marijuana in the final assessment period. For each of the three drug-related activities examined, the largest proportion of youth who engaged in sexual intercourse never engaged in drug-related activity, and the next largest proportion initiated sexual involvement before drug use. Sensation-seeking scores, which were relatively stable across time, were lower among girls, and also were lower among youth who remained uninvolved in drug-related behaviors. For all three drug-related behaviors, rates of high-risk sex were higher among youth who initiated both sex and drugs, and were lower among youth who reported engaging only in sex. Although youth who did eventually initiate drug use had higher perceived levels of family and peer drug use compared to those who remained uninvolved, these perceptions did not contribute directly to high-risk sexual behavior. Conclusions: Youth who will become both sexually active and involved with drugs during adolescence are especially vulnerable to involvement in high-risk sexual behavior.

STUDY OBJECTIVE—To examine the geographical variation in self perceived morbidity in the south west of England, and assess the associations with rurality and social deprivation. DESIGN—A geographically based cross sectional study using 1991 census data on premature Limiting Long Term Illness (LLTI). The urban-rural and intra-rural variation in standardised premature LLTI ratios is described, and correlation and regression analyses explore how well this is explained by generic deprivation indices. Multilevel Poisson modelling investigates whether Customised Deprivation Profiles (CDPs) and area characteristics improve upon the generic indices. SETTING—Nine counties in the south west of England PARTICIPANTS—The population of the south west enumerated in the 1991 census. MAIN RESULTS—Intra-rural variation is apparent, with higher rates of premature LLTI in remoter areas. Together with high rates in urban areas and lower rates in the semi-rural areas this indicates the existence of a U shaped relation with rurality. The generic deprivation indices have strong positive relations with premature LLTI in urban areas, but these are a lot weaker in semi-rural and rural locations. CDPs improve upon the generic indices, especially in the rural settings. A substantial reduction in unexplained variation in rural areas is seen after controlling for the level of local isolation, with higher isolation, at the wider geographical scale, being related to higher levels of LLTI. CONCLUSIONS—This study highlights the need to treat rural areas as heterogeneous, although this has not been the tendency in health research. Generic deprivation indices are unlikely to be a true reflection of levels of deprivation in rural environments. The importance of CDPs that are specific to the area type and health outcome is emphasised. The significance of physical isolation suggests that accessibility to public and health services may be an important issue, and requires further research. Keywords: rural health; limiting long term illness; deprivation indices

This study evaluated the contribution of prenatal perinatal neonatal and postnatal factors to the prevalence of cognitive disabilities among children aged 2-9 years in Bangladesh. A two-phase survey was implemented in 1987-88 in which 10299 children were screened for disability. In multivariate analyses significant independent predictors of serious mental retardation in rural and urban areas included maternal goiter (rural odds ratio (OR) = 5.14 95% confidence interval (CI): 1.23 21.57; urban OR = 4.82 95% CI: 2.73 8.50) and postnatal brain infections (rural OR = 29.24 95% CI: 7.17 119.18; urban OR = 13.65 95% CI: 4.69 39.76). In rural areas consanguinity (OR = 15.13 95% CI: 3.08 74.30) and landless agriculture (OR = 6.02 95% CI: 1.16 31.19) were also independently associated with the prevalence of serious mental retardation. In both rural and urban areas independent risk factors for mild cognitive disabilities included maternal illiteracy (OR = 2.48 95% CI: 0.86 7.12) landlessness (OR = 4.27 95% CI: 1.77 10.29) maternal history of pregnancy loss (OR = 2.61 95% CI: 0.95 7.12) and small for gestational age at birth (OR = 3.86 95% CI: 1.56 9.55). Interventions likely to have the greatest impact on preventing cognitive disabilities among children in Bangladesh include expansion of existing iodine supplementation maternal literacy and poverty alleviation programs as well as prevention of intracranial infections and their consequences. Further population-based studies are needed to confirm and understand the association between consanguinity and serious cognitive disability. (authors)

Background: Persons with mental illness are over-represented among the homeless relative to the general population, and mental illness is most likely one of many vulnerabilities that confer risk for homelessness. Method: This paper elucidates the pathways to homelessness for persons with mental illness by comparing and contrasting groups of mentally ill homeless persons, non-mentally ill homeless persons, and housed mentally ill persons drawn from RAND's Course of Homelessness (COH) study and the Epidemiological Catchment Area (ECA) survey. Results: Homeless persons share childhood histories of economic and social disadvantage. The mentally ill homeless appear to have a “double dose” of disadvantage: poverty with the addition of childhood family instability and violence. Among the mentally ill homeless, those who became homeless prior to becoming mentally ill have the highest levels of disadvantage and disruption; while those who become homeless after becoming ill have an especially high prevalence of alcohol dependence. Conclusions: Mental illness may play a role in initiating homelessness for some, but is unlikely in and of itself to be a sufficient risk factor for homelessness. In addition to outreach and treatment programs for adult mentally ill homeless persons, emphasis should be placed on interventions with children and on addressing more pervasive causes of homelessness.

The introduction of the contraceptive implant Norplant has focused attention on how social factors may affect contraceptive use. In the United States, race is a central category of social organization which may impact Norplant use. I use data from the 1995 National Survey of Family Growth to answer three main questions. (1) Are women of color more likely to use Norplant? (2) To what extent can racial differences in Norplant use be explained by a structural bias in the provision of medical care? (3) To what extent can racial differences in Norplant use be explained by life circumstances which may affect individual women's contraceptive decisions? I find that African American and Native American women are more likely than white or Asian American women to be recent Norplant users. There are no differences in recent use by Hispanic origin. Both a structural bias in the provision of care and differences in life circumstances account for the disparity in Norplant use between African Americans and whites. However, none of the factors examined here explain Native American women's high rate of use. Concerns about health risks for Norplant use are also discussed. These findings point out the importance of examining structural, individual and health status factors in studies of the use of health services.